ACTA MEDICA PERUANA

The viralization of non-communic

2023-02-14T14:50:45-05:00

Metabolic control and its relationship with peripheral arterial disease in subjects with type 2 diabetes mellitus: A matched case-control study.

2023-02-13T17:25:27-05:00

Objective: To assess the relationship between metabolic control and peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (DM2) in Maria Auxiliadora Hospital (MAH). Material and methods: This is a sex-matched case-control study with a secondary analysis based on data from the endocrinology service of MAH, Lima, Peru. Cases with PAD were defined as those with <0.9 ankle-to-arm index (ATAI). Controls were those subjects with ATAI between 0.9 and 1.3, under a 4:1 relationship with respect to cases. Poor metabolic control was defined as follows: glycated hemoglobin ≥7%, systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, HDL cholesterol <40 mg/dL (males) or >50 mg/dL (females), LDL cholesterol ≥100 mg/dL and triglycerides ≥150 mg/dL. Odds ratio values for poor metabolic control were calculated, both crude and adjusted, according to the presence or PAD, by using logistic regression. Results: We included 39 cases and 157 controls. A great majority of cases (94.9%) and of controls (82.2%) had poor metabolic control, respectively (p<0.05). When adjusting for age, time with diabetes, body mass index, and history of tobacco use, patients with poor metabolic control had OR at 5.45 (95% CI: 1.17 – 25.2) and p= 0.030 for having peripheral arterial disease, as defined by ATAI <0.9. Conclusion: Poor metabolic control showed and independent relationship with PAD in DM2 patients in Maria Auxiliadora Hospital. If therapy was only centered in glycemic control, it would increase the burden of disease of macrovascular complications.

COVID-19 lethality in hospitalized adults during the first two pandemic waves: An experience of the private sector in Peru

2023-03-14T13:16:23-05:00

Introduction: The fatality rate from COVID-19 in Peru was 9.1% in 2020-2021, the highest in the world. Objectives: to describe the fatality rate due to COVID-19 in adults hospitalized in a private clinic in Lima, Peru during the first two pandemic waves and to evaluate its associated factors. Materials and methods: Analytical cross-sectional study in April-September 2020 (first wave) and January-May 2021 (second wave), in patients over 18 years of age treated for COVID-19 in a private clinic in Peru, obtained by simple random sampling. Statistical tests were applied considering p<0,05, using IBM SPSS 27.0. Results: The sample was 263 and 235 patients in the first and second wave, the median age was 51 and 49 years in each period and in both moments the male sex predominated with 72.9% and 63.2%. The fatality rate was 7.7% and 6% in each pandemic wave. Between both waves, a difference was found regarding sex and respiratory rate. The factors associated with fatality in both waves were age, SatO/FiO and lactate dehydrogenase (LDH). Conclusions: The fatality rate due to COVID-19 in adult patients hospitalized in a private clinic during the first two pandemic waves was low and the associated factors were age, SatO/FiO and LDH.

Variation of quality of life in patients with Obstructive Sleep Apnea Hypopnea Syndrome after treatment with mandibular advance device

2023-02-17T15:48:03-05:00

Objective: To determine the variation of the Quality of Life in patients with mild to moderate Obstructive Sleep Apnea Hypopnea Syndrome, after treatment with the Mandibular Advancement Device at an altitude of 3259 masl. Methods: Prospective, quasi-experimental study. Subjects with respiratory disturbance index (RDI) between 5 and 30 / hour (measured with respiratory polygraphy), without previous treatments, with conditions for the use of MAD were included. The quality of life was assessed with the FOSQ (questionnaire of functional sleep results) before and after 45 days of treatment with MAD. Results: 26 completed the study (20 males). The mean (SD) of the age was 43 (9.6) years, BMI was 29 (8.6) kg / m2, and the RDI was 19 (7.6) / hour. After 45 day, significant changes were observed, with respect to the baseline values, in the FOSQ score (total calculation, general productivity, social outcome, activity level, vigilance and intimate relationships/sexual activity, p <0.001). The mean RDI decreased from 19 (7.6) to 7 (3.8) (p <0.001), the minimum desaturation of O2 increased from 77 (5.2) to 83 (3.9) (p <0.001), the T90 decreased from 73 (15.4) to 31 (16.6) (p <0.001) y Epworth's score decreased from 11.2 (4.6) to 6.4 (3.5) (p <0.001). Conclusions: In patients with mild-moderate OSA, treatment with MAD produces significant improvement in their quality of life, reduces the level of disease expressed in decreased RDI, improves oxygenation level and reduces daytime sleepiness expressed in decreased Epworth score.

Severity Tomographic Score (TSS) as a predictor of admission to Intensive Care Unit (ICU) in patients with COVID-19 pneumonia in San Juan de Lurigancho Lima, Peru

2023-02-13T17:41:30-05:00

Objective: To determine if the Tomographic Severity Score (TSS) of patients with COVID- 19 pneumonia at admission, as well as some laboratory tests or clinical features predict ICU admission in this group of patients. Material and methods: Case-control study, which included patients with a clinical diagnosis of SARS-CoV2 virus infection, performed by reverse transcriptase polymerase chain reaction (RT-PCR), reactive serological test (IgM / IgG) and/or Computed Tomography of the chest (CTT) without contrast. Two radiologists (blind evaluators) described the tomographic findings. The data were taken from electronic medical records (EHR). The most important variables for the prediction of ICU admission were analyzed: TSS, age, BMI, obesity, ferritin, D-Dimer, O2 saturation, PO2, lymphopenia, C-reactive protein, and presence of comorbidities: Diabetes Mellitus, HTN. The prediction of admission to the ICU was performed using binary logistic regression for an adjusted OR, which compared 2 analysis models with a 95% CI and a p value <0.05; as statistically significant Results: 168 participants were included. The most frequent comorbidity was arterial hypertension, followed by Type 2 diabetes, the most frequent symptoms in our series were cough, malaise, fever and respiratory distress, there were no significant differences between the groups studied (admitted to ICU and not admitted to ICU). The mean age of the patients not admitted to the ICU was 44.89 ± 10.9 years and of those admitted to the ICU 43.81 ± 11 years (p: 0.669). The mean value of the TSS Score was 14 (SD 4.44) in ICU patients vs. 7.77 (SD 4.81) in Not admitted to ICU (p <0.001), the mean D-Dimer was 0.78 (SD 2.74) in Not admitted to ICU vs. 4.72 (SD 9.72) in ICU admitted (p <0.001). In addition, the prediction for ICU admission by binary logistic regression was shown in Model 2; than the following variables: TSS (OR: 1.24) (95% CI 1.08- 1.43) (p₌ 0.002), BMI (OR: 1.19) (95% CI 1.02-1.39) (p₌ 0.022), Age (OR: 0.94) (95% CI 0.89-0.99) (p₌ 0.047) and D-Dimer (OR: 1.14) (95% CI 1.04-1.26) (p₌ 0.05), were the variables with the best predictive value. Conclusions: The TSS Score was useful in the initial diagnostic evaluation of COVID-19 pneumonia, in conjunction with markers such as D-Dimer, BMI and age that can predict a poor result in the short term. A TSS Score ≥ 8 in patients with COVID 19 pneumonia at hospital admission can be considered a predictor of admission to the ICU in the patients studied.

Prevalence and components of premorbid metabolic syndrome in workers insured by social health in an area of moderate altitude in Peru

2023-02-13T17:41:47-05:00

Objective: To analyze the prevalence and components of pre-morbid Metabolic Syndrome (MS) in workers insured by social health in a moderate altitude area (Chachapoyas, Peru). Materials and methods: A cross-sectional study was conducted with data from various types of workers belonging to a program focused on diagnosing pre-morbid MS, obesity and overweight in workers in their workplaces during the period from October 2017 to August 2018. Data previously recorded by the program were used. MS was diagnosed according to the criteria of the guide "Harmonizing the Metabolic Syndrome". Results: A total of 1021 subjects were included. The overall prevalence of pre-morbid MS was 32.8% (312/952). In men, the prevalence was 35.4% (160/452) and in women 30.4% (152/500), with no statistically significant differences between sexes (p = 0.101). The frequency of the components of MS in the total population of the study was: Central obesity 73.4%, hypertriglyceridemia 45.6%, low HDL-C 66.3%, hyperglycemia 10.0% and high blood pressure 6.5%. Participants with premorbid MS were significantly older than those without pre-morbid MS (44 versus 36 years, p <0.001). Conclusions: There is a high prevalence of pre-morbid MS in workers residing in Chachapoyas, contrary to what previous evidence suggests.

Therapeutic hypothermia for the management of hypoxic-ischemic encephalopathy in asphyxiated newborns: Clinical, electrographic and radiologic features of newborns treated at Instituto Materno Perinatal

2023-02-13T17:42:02-05:00

Hypoxic-ischemic encephalopathy (HIE) is the neurological syndrome caused by perinatal asphyxia. Therapeutic hypothermia (TH) has been shown to reduce HIE-associated morbidity and mortality. A descriptive and retrospective study with 30 newborns with moderate and severe HIE who underwent TH in the Intensive Care Unit (ICU) of Instituto Materno Perinatal, from September 2017 until November 2020. Nine patients were severely affected (30%). The average tome for being admitted in the ICU was at 3.4 hours of life. No important adverse effects attributable to TH were observed. All severely affected patients experienced epileptic crises, and abnormal cerebral ultrasonography and magnetic resonance imaging studies on admission. Mortality was 20.0%, but it was significantly lower in the group with moderate HIE. Clinical, electrographic, and radiological characteristics of neonates with HIE who underwent therapeutic hypothermia were identified. This procedure has been shown to be safe and effective.

Comparison of two isothermal methods for SARS-COV-2 screening in Callao, Peru

2023-03-15T23:53:05-05:00

Objective: To compare the isothermal molecular screening techniques CPA and RT-LAMP, against the gold standard test, reverse transcription quantitative polymerase chain reaction (RT-qPCR), and to determine its agreement.

Materials and Methods: Paired comparative case-control study. For the evaluation of the CPA method, 70 cases and 130 controls were used, while for RT-LAMP, 30 cases and 70 controls were used. The sensitivity and specificity of both tests were calculated. Subsequently, the bias-corrected Kappa index was calculated by resampling.

Results: Both techniques have adequate and equivalent values of sensitivity (RT-LAMP: 82.8%, CPA: 83%) and specificity (RT-LAMP and CPA: 91.5%), as well as a high concordance (88%), and Kappa-index (0.72).

Conclusion: Both isothermal molecular screening techniques are suitable for SARS-CoV-2 screening, with a similar sensitivity and specificity.

Monkeypox (MPOX) in an HIV negative heterosexual male patient

2023-02-13T17:42:37-05:00

We present the case of a 28-year-old male patient, heterosexual, with negative HIV who developed an intense skin rash characterized by the presence of confluent vesicles, pustules, and umbilicated papules on the penis and pubic region with little spread to the rest of the body, without lymphadenopathy or systemic manifestations, four days after having sexual relations with an apparently healthy prostitute. The swabbing of the dermal lesions revealed the presence of MPOX virus DNA by real-time PCR. The immunological tests were the following: negative fourth-generation ELISA and Western Blot for HIV, IgM antibodies to herpes simplex1=1.2 U/ml, IgM antibodies to herpes simplex2=1.9 U/ml, IgM antibodies to varicella zoster=0.5 S/CO and negative FTA-ABS (IgM) for syphilis. The intensity of skin lesions on the penis and the need to perform tests to rule out MPOX in prostitutes are highlighted.

Disseminated Gonococcal Infection: Case report

2023-02-13T17:42:59-05:00

Introduction: Infection by Neisseria gonorrhoeae (NG) is the second cause of sexually transmitted disease (ETS), with an increasing incidence, high rates of antibiotic resistance and with its greatest presentation at the genital level. Its presentation with bacteriemia is less than 3%, limiting its diagnosis due to its low performance. Therefore, we report the case. Case presentation: 60-year-old man with a history of diabetes mellitus, who was admitted due to polyarticular symptoms with synovitis, associated with a febrile syndrome, with no other finding on physical examination. Bacteremia due to Neisseria gonorrhoeae is documented, with a temporal link with previous sexual intercourse. Antibiotic treatment is indicated according to antibiogram with partner prophylaxis. Patient is discharged without any complications. Conclusion: Hematic dissemination by NG is a rare condition, with very non-specific initial symptoms, with low performance of diagnostic tests in this condition, which requires high clinical suspicion, and a very detailed clinical history is of great importance. As in our case, nonspecific symptoms led to ruling out other conditions until isolation in blood cultures leads to a definitive diagnosis. It is a case with unusual clinical presentation

Splenic lymphangiomatosis in an adult patient Case report

2023-02-19T16:43:41-05:00

Lymphangiomas are benign malformations of the lymphatic system. They most often affect children and rarely adults. We present the case of a 36-year-old woman with a 6-month clinical picture of diffuse abdominal pain without peritoneal irritation associated with adynamia. As part of the studies, a computerized axial tomography with abdominal contrast was requested, which revealed multiple hypovascular hypodense splenic lesions with suspected diagnosis of lymphoproliferative lesions. For this reason, a diagnostic splenectomy was requested, which showed macroscopic, microscopic and immunohistochemical findings (positivity of cystic lesions for CD31 and D2-40) compatible with diffuse splenic lymphagiomatosis.

Patient with Rosai-Dorfman-Destombes disease: 18F-FDG-PET/CT scan as a diagnostic tool

2023-02-17T10:53:24-05:00

Rosai-Dorfman-Destombes disease (RDD) is a rare non-Langerhans cell histiocytosis, with sinus involvement and massive lymphadenopathy. RDD is usually self-limited; it can appear alone or related to other diseases. We present a 9-year-old male with biopsy of that lesion was taken, giving as result a benign histiocytosis, compatible with RDD. The patient was scanned with full body 18F-FDG PET/CT, the results of the study showed hypermetabolic focal lesions in the sphenoid sinus, ethmoid sinus, and bilateral nasal involvement with hypermetabolic focal injury in the middle third of the left tibia, findings in relation to high-grade expansive injury. The study of 18F-FDG PET/CT demonstrated avid FDG lesions at nodal and extranodal sites, and it also can be used in monitoring and/or evaluating response to treatment.

Terminology in virtual medical education

2023-02-16T23:14:15-05:00